Provider Demographics
NPI:1952391260
Name:BATCHELOR, TRACY TODD (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:TODD
Last Name:BATCHELOR
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:60 FENWOOD RD # YAW9
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6128
Practice Address - Country:US
Practice Address - Phone:617-732-5500
Practice Address - Fax:617-724-8769
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA817332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ31719OtherBCBS MA
MA3147266Medicaid
MA727787OtherTUFTS HEALTH PLAN
MA3147266Medicaid
MAA20848Medicare ID - Type Unspecified